Long lasting hypercoagulability after subclinical COVID-19
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Long lasting hypercoagulability after subclinical COVID‑19 Paolo Ferroli1 · Chiara Villa2 · Andrea Ciuffi1 · Guido Gubertini3 · Morgan Broggi1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Highlights • During COVID-19 pandemic emergency, a patient with a • • • •
previous undiagnosed subclinical COVID-19 underwent urgent surgery for removal of a big intracranial tumor. The patient developed severe APE secondary to atrial catheter-related thrombosis in the post-craniotomy clinical course. Previous COVID-19 is suspected to be the main cause of the prothrombotic status of this patient, otherwise healthy and without any other risk factor for DVT/APE. The temporal evolution of the hypercoagulability state in COVID-19 is still unknown. Special attention is required when planning major surgical procedures in patients with previous COVID-19.
In the first months of 2020 Coronavirus disease 2019 (COVID-19) became pandemic; the clinical course of the disease and its potential complications still represent an open field of discussion. As pointed out by several authors, initial observations seem to indicate that a hypercoagulability state may be associated with COVID-19 and complicate the course of the disease [1–3]. We present and discuss the association between severe acute pulmonary embolism (APE) secondary to atrial catheter-related thrombosis in the post-craniotomy clinical course of a patient with a previous subclinical COVID-19. This case raises concerns about the duration of inflammatory state and hypercoagulability in this new disease. * Morgan Broggi morgan.broggi@istituto‑besta.it 1
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milano, Italy
2
Department of Radiology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
3
Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
On March 20th 2020, a severe APE secondary to thrombosis of a central venous catheter (Fig. 1a, b) was diagnosed post-operatively in a 39 years-old patient admitted to our ward, who was coming from a COVID-19 red zone (Bergamo district, north of Italy). Six weeks before admission he presented mild fever and cough that recovered spontaneously in few days; he did not further investigate these symptoms. Despite elective craniotomy restrictions due to the COVID19 emergency, he required urgent surgery because of a 4 cm suprasellar craniopharyngioma that was causing rapid decline of his visual function. The patient was otherwise healthy, without any comorbidity. Preoperative hematologic routine examinations did not disclose any abnormality. Complete trans-nasal endoscopic tumor resection was achieved without any immediate postoperative complications on March 16th 2020. His visual acuity rapidly improved and post-operative Magnetic Resonance confirmed complete resection of the lesion without any intracranial complications. Within postoperative medications (e.g. steroids, desmopressin), also standard
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